Goal: Benign prostatic hyperplasia (BPH) is a common condition among older men that often leads to bladder obstruction. This study aims to compare the safety and surgical outcomes of two treatment options for BPH patients with large prostates (>80 g): open prostatectomy (OP) and transurethral bipolar enucleation and resection of the prostate (TBERP). Methods: A randomized, prospective clinical trial was conducted on BPH patients over 50 years old with a prostate volume >80 mL, maximum flow rate (Qmax) >15mL/s, and International Prostate Symptom Score (IPSS) >8, meeting established surgical indications. Patients were randomly assigned to either OP or TBERP. Intraoperative blood loss, operation time, resected prostatic tissue weight, postoperative catheterization, and hospital stay period were recorded. Patients were also assessed for IPSS, post-voiding residual urine, prostate volume, and complications (including catheterization, urinary retention, urinary tract infection, irritative symptoms, urinary incontinence, urethral stricture, and bladder neck contracture) over a three-month follow-up period. Results: The study enrolled 64 patients with a mean age of 62.6 and 61.8 in the OP and TBERP groups, respectively. TBERP resulted in significantly less bleeding (p=0.139) and shorter catheterization and hospital stay periods (p<0.001 and <0.001, respectively), but no significant difference in operation time, resected tissue weight, or post-operative IPSS (p=0.214, 0.219, and 0.956, respectively). During the three-month follow-up period, OP and TBERP had statistically equivalent outcomes regarding early and late complications. Conclusion: TBERP is a safe and effective alternative to OP for BPH patients with large prostates, with less bleeding and a quicker recovery period.